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Preserving the posterior ligament complex in lumbar surgery may mitigate adjacent segment disease

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CHICAGO — Among 172 patients prospectively studied and followed for 8 years after either total laminectomy and fusion or semilaminectomy and fusion for L4-5 degenerative spine disorders, investigators from Shaanxi, China, reported 59.9% of patients developed adjacent segment disease.

“The incidence of [adjacent segment disease] ASD was significantly higher after total laminectomy than semilaminectomy. Preserving the posterior complex as much as possible during lumbar fusion surgery plays an important role in preventing ASD and in reducing the reoperation rate,” Dingjun Hao, MD, said, at the North American Spine Society Annual Meeting, here.

Hao and his colleagues hypothesized the integrity of the posterior ligament complex was important in relation to ASD. To study this, they enrolled 190 adult patients (101 men, 89 women) between January 2004 and January 2007 who required surgery for lumbar disc herniation (DH), DH with instability or DH with stenosis. Investigators randomized patients to either total laminectomy with L4-5 fusion (group A) or semilaminectomy with L4-5 fusion (group B).

“There was no statistical difference between the two groups,” Hao said.

The investigators defined ASD as one or more lesions at segments adjacent to the fusion and not seen preoperatively, he said. The outcome measures included the radiological results used to detect any disc degeneration, fusion rates, and the Oswestry Disability Index and VAS pain scores.

After exclusion criteria were applied, Hao noted the radiological ASD rate was 56.9% and the symptomatic ASD rate was 2.9% at the most recent follow-up.

“The incidence of ASD in group B was significantly lower than group A,” he said.

Hao added, “Fusion was achieved in all patients.” – by Susan M. Rapp

Reference:

Yan L, et al. Paper #31. Presented at: North American Spine Society Annual Meeting; Oct. 14-17, 2015; Chicago.

Disclosure: Hao reports no relevant financial disclosures.